Time Off Request

* Indicates required questions
Please complete all sections.
Name *
First Last
Postition *
Employment Status *
Use Paid Time-Off ("PTO") for this TOR: *
Type of Hours Requested *
Number of hours requested: *
Supportive documentation included? Please send separately. (I.E. Jury Duty Summons, Doctors Note, Return to Work, etc.) *
Not available as of (Please use XX/XX/XX format):  *
at (time): *
Can return as of (Please use XX/XX/XX format): *
at (time): *
REQUIRED - Brief explanation of absence: *
Employee Signature - Please Type *
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